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Billing For Laceration Repairs

What's the difference between simple, intermediate, and complex repairs? What do you really need to document? Are you missing out on reimbursement?

 

These procedures can sometimes be confusing. A complicated laceration does not necessarily mean that the repair is intermediate or complex. There are a few questions to ask to determine what type of repair needs to be done.

 

How deep is the laceration? Is it contaminated with foreign material? Is debridement necessary?

 

See the following descriptions of the different coding options:

 

Simple Repair - One layer skin closure, or electrocautizeration without closure. Most insurances consider skin adhesive, such as Dermabond, as a simple repair.

 

Intermediate Repair - Layered closure of one, or more, of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure. You can also bill an intermediate repair for a single-layer closure of a heavily contaminated wound that required extensive cleaning, or removal, of particulate matter.

 

Complex Repair - Wound requiring more than a layered closure, such as: scar revision, extensive undermining, stents, or retention sutures. Necessary preparation includes the creation of a limited defect for repair, or the debridement of a complicated laceration or avulsion.

 

There are a few more items to document in addition to your detailed description of the repair. Such as, the location of the laceration (obvious, I know) and the length of the laceration repair in centimeters.

 

Why does it matter? Laceration repairs are coded according to the type of repair, anatomical location, and the length of the repair.

 

What if there are multiple lacerations? If the lacerations are the same type of repair (meaning simple, intermediate, or complex), AND in the same body area group, the length of the lacerations will be added together and billed as one repair. If not, then the repairs will be billed separately.

 

So, what can't you bill? Lacerations that are cleaned, but left open to heal are not separately billable, as well as, wounds repaired with adhesive strips. In these cases, an Evaluation and Management (E/M) code will be billed instead.

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“It's amazing how much the proper coding makes a difference in your claims and collections. Thank you Kelli and Team for showing us what we've been missing.”

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